How Would We Know If We Really Reformed the Mental Health System?

I have been wondering for some time how we would know if the mental health systems in the United States were really reformed. It is true that there are “a thousand points of light”—many great new and older programs and initiatives out there with tremendous advocacy and efforts at radical change. But when a system leaves so many without recovery-oriented supports, it is like swimming upstream against a powerful current. Here are 20 indicators that if fully implemented would represent a complete system reform.

1. No one would ever be told they had a “chronic mental illness.” Everyone would be told they can expect to recover, i.e., get a life back that will be reasonably happy and productive.

This term, along with most if not all diagnostic labels, gets used so casually that unless you’re the one on the other end of it, it’s not even evident that it carries a huge negative impact. Besides, it’s not accurate. Most people can and do get their lives back in gear—if the “system” stays out of the way or provides services in a truly recovery-oriented manner. And by “recovery-oriented manner” I don’t mean waving the term around like a flag without actually changing practices. Recovery has become a popular catchphrase but the reality may not match the public relations initiative.

2. Every prescribing professional will be educated about what well-constructed unbiased research tells about the relationship between psychiatric medications and recovery.

The blank looks that appear when mention is made of the work of Robert Whitaker, Peter Goetzsche, Martin Harrow and Lex Wunderink tell us a lot about whether prescribing professionals are up-to-date on what research actually says. Often there are hostile and defensive postures from tradition-bound psychiatrists—most of whom have never read or studied the work of these courageous researchers. Fortunately, there is an increasing number of all types of mental health professionals who are opening up to this knowledge base—sometimes admitting that secretly they have been reading Anatomy of an Epidemic. Professional and continuing education is a critical need.

3. Every person who comes in for service is provided with full informed consent about psychiatric medications.

To achieve this reform, “Accepted Community Treatment” standards would need to be changed significantly. Far too often, current practice consists only of the most cursory review of possible side effects like dry mouth. Full informed consent is highly unusual. This is partly related to the lack of knowledge among physicians themselves, but underlying this dynamic is often something more telling: a lack of respect for informed consent itself and a preoccupation with “compliance”—if a patient really knew all about the medications, they would be non-compliant. “Compliance” is a term that should be eliminated because it reflects the belief that “psychiatric patients” are unreliable, will rebel against psychiatric expertise, or they lack “insight.” A carefully constructed new standard for what constitutes full informed consent is urgently needed.

4. Every mental health program will implement and maintain a medication tracking system and use it to recognize over prescribers and provide them with additional education, monitoring and supervision.

It is feasible in most programs to create a digital quality assurance tool that would track: 1) the psychiatric medications 2) each prescriber in the program is prescribing, 3) in what dosages 4) for how long, 5) to which people 6) with which diagnoses and 7) the ages of the patients. This data would be analyzed to determine which prescribers are prescribing in excess of what research and safety standards should dictate. Targeting education tools could then be created to make changes consistent with evidence-based medication practices.

5. Every mental health program of all types and settings will offer peer services and supports to guide recovery.

This system improvement may be further along than any of the other elements in this blog. That is in part because there have been peer services and supports offered in many states for three decades or more. A listing of just some of those in Oregon alone would be David Oaks’ MindFreedom International, the Mind Empowered Inc’s Community Survival Project, Folktime and Dual Diagnosis Anonymous. Readers of this blog will be able to add many more such as Hearing Voices Network and others around the US, Canada, the UK, Australia, New Zealand, and many other countries. These kinds of services and supports should be required and available and accessible to anyone who wants them.

6. Every program will provide eCPR training to assure its inclusion in all crisis service systems.

This is a perfect example of something that persons with lived experience know about and have almost uniformly supported as an alternative to the more mainstream approach represented by Mental Health First Aid. No one really understands what it’s like to be “handled,” often literally, in a crisis except those who’ve been through it themselves. The nuances are lost on many crisis workers. There have been enhancements to some emergency services by adding persons with lived experience to standard operating procedures, but far more needs to be accomplished here, and a starting place would be to ensure that at least an eCPR training or its equivalent is implemented in every community.

7. Every program will provide outreach as well as in-person crisis services with staff educated in psychiatric medication practices to minimize use and optimize for assistance in regaining sleep and lowering emotional distress.

Crisis programs are still almost exclusively offered in clinic settings or through “hotlines.” And these services often revolve around getting the person back on their medications or starting new ones in an attempt to “restore the chemical imbalance.” Much greater recognition is needed to recognize the chemical imbalance created by the psychiatric medications themselves. How many crisis workers know about “dopamine supersensitivity”? There may be a place of some use of medications to help with sleep or lowering emotional distress—even Open Dialogue uses medication in about 30% of the youth served. If the crisis results from an abrupt discontinuation or overly quick tapering off medications, a slight temporary increase could be in order. But these considerations can only be implemented when staff are far more educated than is common now.

8. Every emergency room will have staff specifically trained in skills, knowledge and attitudes that accept persons in severe emotional crisis and provide a specialized calming unit for first-line assessment and triage.

I have recently been in communication with a psychiatric nurse who specializes in working in emergency rooms all over the country. She believes that one of the things peer and other advocates may not always recognize is that in an ER, the overriding priority is patient—all patients, psychiatric and medical—and staff safety. This means that the need to keep things calm often requires more medication and even some degree of physical safety restraint when things get out of control. But these kinds of interventions would be far less common if ERs were restructured so that there was a separate unit which has a calming environment rather than the usual chaos of an ordinary ER. It would be staffed by people who are comfortable with psychotic experiences and who actually like being around people who are suicidal, angry, confused, hearing voices, or whatever. Where persons in psychiatric crises are dressed in specially colored “gowns,” this discriminatory practice should be eliminated. In addition, each community mental health program should have a Soteria House or something similar so that there are places nearby where a person can go as soon as possible rather than being sent to an acute psychiatric residential or hospital unit.

9. Every acute care unit will be funded in such a way that length of stay is increased and reliance on over-medication is drastically reduced.

One reason for over-medicating people in crisis is that most units are funded for extremely limited stays. Durations of 6-8 days on average are common so that a premium is placed on rapid “stabilization” subduing the most dramatic symptoms and discharging the patient. This change requires a careful analysis of what additional funding will be needed to allow more days to help a person regain enough stability to move back home or to a more receptive environment without over-medicating them.

10. Every community program will have an Open Dialogue or similar early psychosis intervention program to support youth and families going through a first major episode.

In the latest directory of early psychosis intervention programs in the United States there are over 100 such projects. Some are modeled after the Finnish Open Dialogue approach. An example is the Collaborative Pathway program in Framingham, Massachusetts. A new project is now in Atlanta, Georgia. Both are using psychiatric medications sparingly and very similarly to the original Western Lapland model. Other programs use a combination of psychosocial, family support and to a greater or lesser degree medication, but focus on youth and families clearly experiencing a first psychotic episode. The Oregon EAST/EASA program has seen dramatic outcomes—just one example is a young man who had been threatening to kill his father in their backyard with a shovel was working as a nurse a few years later.

11. Every community mental health program will have both an outpatient service and a facility for psychiatric medication tapering and withdrawal supports.

Programs have an obligation to support those who choose to taper and eventually withdraw and to do so safely and effectively. Many have done this without much support and it certainly is possible. However, it is sometimes a difficult and lonely process. We are still learning about what works and the current Mad in America Continuing Education webinars are focused on this topic and can be accessed here. These tapering and withdrawal centers must employ peers who have been through the process themselves.

12. Every crisis system will be reorganized to reduce reliance on involuntary treatment and eliminate forced medication.

This reform requires major shifts in social policy and reflects far more than the challenging task of reorganizing crisis services described in #7 above. There would need to be re-training of courts and ER/medical/psychiatric staff to think beyond resolving immediate crises by leveraging “cooperation” through “compliance.” Peers who have been through episodes where risk of harm to self or others were involved to work closely in a reorganized system. I believe we need to advance far beyond the often rhetorical arguments on all sides and go to work on practical solutions.

13. Every program created to respond to Olmstead-type deinstitutionalization requirements will develop a true community-integration initiative to ensure that the individuals become parts of the neighborhoods and not just live in them.

In 1994, Oregon closed a troubled 300 bed state hospital and we were very proud of doing it “the right way” by creating community programs and placements for every person able to be discharged. Those who could not be discharged were temporarily transferred to other state hospitals. Each year for about the next six or eight we created about 100 more placements so that there were 1,000 more available in what was called the Extended Care system. The best clinicians in the state were hired to work with the discharged persons and the programs to make sure they were receiving the right level of care and not just discharged for the sake of moving them to lower levels of care. Fast forward to the community created on the grounds of the closed state hospital. NAMI advocates advocated to establish five programs there. The residents of the group homes and supported housing units are rarely seen outside their homes or apartments. When they are, it’s pretty obvious because they are almost all slumped over, walking with heads down, clearly victims of metabolic syndrome. They are just as isolated as they were in their state hospital days. A reformed system would find ways to truly integrate them with outreach and educating neighbors, by initiating things like gift exchanges at holiday season, by organizing social activities at the community center and making sure that individuals are welcome. I think we have only scratched the surface on making Olmstead-type deinstitutionalization truly deinstitutional.

14. Every program will provide supported employment, education and housing to every individual who wants these services.

This is another significant need given the high unemployment rate among people with major mental health challenges. The same goes for the high rate of risk of homelessness. Many individuals had their education interrupted and never restarted because of their initial mental health crisis. These models have existed for many years and are still in operation in many communities but far from meeting the needs.

15. Every program will provide outreach to jails, juvenile correction facilities, and prisons to ensure transitions and supports including psychiatric medication information and planning to reduce them over a reasonable time.

A great outcry exists in every advocacy forum, from NAMI, to child and youth advocates, to those with lived experience, to mental health professionals—and to the prisons, youth correctional facilities and jails themselves. The reality inside is that many are being over-medicated and kept confined individually or collectively. They are isolated from their home communities, friends and service supports. Since about 90% have been shown (by Linda Teplin at Northwestern University) to also have alcohol and other drug problems, they need careful evaluation to determine first whether or not their mental health symptoms were primarily a result of their usage. It should be well-known that alcohol and street drugs can mimic any mental health disorder. For those who do have mental health problems, there should be more knowledge about the use of medications and a tapering program in each facility. Improved discharge planning would connect individuals with peer supports like DDA and other services to make successful transitions back into the community.

16. Every program will claim budget savings from reduction of psychiatric medication use and re-invest it in the services in this list as needed and guided by peer input.

The pharmaceutical corporations have lobbied successfully with state legislatures to keep the budget for psychiatric drugs untouchable. In practical terms, mental health administrators in public programs (except for maybe state hospitals) usually have little or no idea of how much these dangerous, expensive and overused drugs cost. In Oregon, we estimated that of the two-year budget of about $1 billion, the state was spending another $300,000,000 or more on psychiatric drugs in all of the programs that served people with mental health problems—outpatient, inpatient, residential. The potential savings are considerable and should be reinvested in reforming the mental health system. The fight with Big Pharma and its allies would be incredibly heated.

17. Every program will have a policy advisory body composed of at least 80% peer advocates.

How long have we been shouting “Nothing about us without us”? States like Oregon have such a board with 100% peers. That kind of advisory body would be a beginning, but there would need to be additional advocacy to get the recommendations that come out of such bodies respected and implemented.

18. Every program will have a continuing education initiative using online and other learning forums.

Most, if not all, of the changes needed to reform the system would require a carefully planned continuing education initiative like the Mad in America Continuing Education project. It is likely that this kind of continuing education resource would need to be mandated by state governments or professional credentialing organizations, although more successful services and supports could be inspiring enough that voluntary participation would be sufficient motivation.

19. All program administrators and managers will be required to read Anatomy of an Epidemic and Psychiatry Under the Influence as basic knowledge resources.

These two books have formed the foundation for rethinking the role of psychiatric medications and the enormous influence of the pharmaceutical corporations in shaping the guild interests of psychiatrists. There are many other thought leaders who should be included, like Peter Breggin and Peter Goetzsche, but Whitaker’s books are key starting places and would lead to more books, articles and research that support all of the changes needed to reform the system.

20. All funding resources will be geared toward making and sustaining these changes rather than presenting barriers.

Maybe this change should have been listed first. One of the difficulties in making reform possible is the multiplicity and complexity of funding for mental health. Medicaid is mind-boggling yet forms the basis of much public financial support. It is by definition a medical model so that it takes considerable creativity and bureaucratic flexibility to make it work for many of the items in this list. One of the gaps that exists for us in the advocacy community is a knowledge of how these kinds of administrative and budget resources work. We need to step up our knowledge as a critical ingredient in our advocacy.

My hope is that this listing of indicators isn’t just an academic exercise—it can be used as an evaluation instrument by simply assigning a number to each of the 20 indicators based on your assessment of where your community mental health system is in implementing them. Here is the scale I recommend:

0 Haven’t even thought of it

1 Starting to place it into planning documents

2 It has been approved for implementation with a date for startup

3 It has started in operation

4 It has implemented in such a way that 50% or more are gaining access to or benefiting from it

5 It is fully implemented

This scale would need to be adapted for some of the items to indicate the degree to which the change has happened.

A score anywhere near 100 will not be achieved anytime soon but whatever the number, it will provide an overall assessment of reform and will lead to both immediate and longer-term goals.

Now you can score your system and keep working toward total reform.

Update: I have created a pdf of this indicator scoring system, which you can view and download here.

Policy for Recovery: As a former state mental health and addictions commissioner, Bob Nikkel writes about policy and practice changes that are needed to promote recovery and resilience while decreasing the over-reliance on psychiatric medications in community and hospital treatment settings. Bob serves as executive director of Mad in America's Continuing Education program.

56 COMMENTS

I’m not angry at you, myself. I would be happy to eliminate coercion in psychiatry–whether through force or deception. Banning television drug commercials and forcing Big Pharma to edit their ad brochures so they don’t tell lies about chemical imbalances in the brain would be a great start.

I also would only allow violent people to be locked up. And they could choose prison over the madhouse and opt out of “treatments” that do nothing to prevent violence and may make it worse sometimes.

The Texas shooter had tried to murder his eleven-month-old son. If he had been locked up as an ordinary felon he would not have been free to commit that mass murder. My guess is he “took his meds” and had “good insight.” I can’t help myself I’m bipolar. Psychiatry makes no distinction between guilt or innocence, so they have no business in the legal system.

Simple. The system that is in place today is the product of reform. Reform will simply create more and more ostensibly sophisticated measures to ensure that psychiatry continues to oppress the innocent. Think of diabolical creativity of Freud and his ilk to reform medicine. Then think of the reforms made to early psychiatry. Reform never has anything to do with actually helping people. Reform has to do with preserving psychiatry as a profession and protecting guild interests. That is why spinning chairs and medieval torture led to electroshock, lobotomies, insulin shock, and a variety of other barbaric practices, culminating in the psychotropic drug “treatments.” Everything present in psychiatry today is a product of reform, and that reform has created progressively more dangerous practices that masquerade as medicine and science. Just think what more reform will do in the future. We may reform our way into the brave new world seen by Aldous Huxley. Those who understand the true history of psychiatry would never work to reform it. Those who understand the true history of psychiatry will work to abolish it. So, psychiatry scores a 0 once again on any scale that has anything to do with human flourishing.

It cannot be abolished as long as 80%? 90% 70% (who knows, but a majority) of the population wants a quick fix. Most people assume that the nasty “side” effects will only happen to someone else.
People have always used drugs. Always wanted to use drugs. Always felt a need. Because they didn’t have the emotional support, or the answers to why they were alive in the first place and how to understand the suffering of the world. Until that changes, we’re just tinkering at the edges.
The article is interesting, but the author is only really addressing what we do with people already in crisis. Forget it – it’s too late by then. We should be exploring how to keep them from falling into crisis in the first place.

Exactly. When we do abolish the present system (if we ever become cohesive enough and powerful enough) we will have to continue to walk with the people presently trapped in the system. They do not deserve to be abandoned.

We must somehow find a way to stop the psychiatry and the drug companies from ever widening their nets so that anything that is normal (whatever that is) becomes pathologized since this is their objective.

Robert Nikkel has this idea, from what I can make of it, of reforming outpatient “care”, but leaving inpatient “care” basically intact. No subtle deception, please. Get rid of forced treatment (inpatient treatment/mental health law) and truly volunteer (outpatient) treatment can take care of itself.

Thanks. Psychiatry can be abolished just like many evil things have been abolished in the past, but it will take courage, fortitude, and wisdom beyond our own. Thomas Szasz wrote a book called “Psychiatric Slavery,” and in it he calls for the abolition of his own profession. It is a book that everyone should read. How did Lincoln create the Emancipation Proclamation? How did Churchill guide the allied forces to victory over the Nazis? How did the colonists gain independence from the tyranny of Great Britain? How did David slay Goliath? These are questions to consider as we work toward the abolition of psychiatry.

Great! Let’s abolish psychiatry! No more “meds,” no more “doctors of the mind.”
But let’s also stop writing as if no more psychiatry means no more human suffering.
In the 19th century, many people dealt with their distress by turning to opium (among other things). That was usually their ticket out of society and into the dregs. Many of them ended up in prison or dead. They were also marginalized by society who feared and loathed them. Okay, they weren’t told that they have permanent brain diseased. But their emotional distress disabled them nonetheless.

We have to take the fight that one step back – identifying the REAL causes of “mental illness,” making “mentally ill” people human again, humans who go through stuff and don’t always get the support they need to make it out the other side.

“We may reform our way into the brave new world seen by Aldous Huxley,” isn’t this where we currently are?

I do believe you forgot to mention in your article about “How Would We Know If We Really Reformed the Mental Health System?” Robert, that we need to abolish all belief in the current, scientifically invalid, DSM disorders, as even confessed to by the former head of the NIMH.

The DSM belief system is the problem. The ADHD drugs and antidepressants create the “bipolar” symptoms, as Robert Whitaker pointed out.

The antidepressants and/or antipsychotics (aka neuroleptics) create both the negative and positive symptoms of “schizophrenia.” The negative symptoms can be created via neuroleptic induced deficit syndrome and the positive symptoms can be created via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

To know we’ve actually reformed today’s “mental health system,” we need to actually see the demise of the DSM belief system, in it’s entirety. Today’s DSM deluded “mental health industry” is actually an iatrogenic illness creation system, as opposed to being a “mental health” industry.

Please consider adding these known adverse drug effects to your DSM, since they were conveniently omitted from the DSM, by psychiatrists who had delusions of grandeur that they should rule the world, at least if you want to continue to claim the DSM has any scientific valid whatsoever.

1. I think the word you are groping for is “chronic under employment”. The difference between a mental patient and a regular citizen basically boils down to a job. “Mental illness” is a term manufactured by “mental health” professionals to drum up business.

2. We should be petitioning institutes of higher education to include Whitaker, Harrow, Goetzsche, et al. in their curricula. We should, as well, find ways to penalize schools that don’t include such in their studies. Theoretical bias can be a big concern, and it needs to be confronted, especially when the evidence points in another direction.

3. The problem with “full informed consent” is completely non-consensual coercive treatment. Now tell me, which goal would be most effective, ending non-consensual coercive treatment entirely, or making “full informed consent” apply in outpatient settings? (b.) Outpatient settings that will also include court ordered drugging.

4. Compulsory medication tracking? And will this medication track also track, and with punitive intent, non-compliance. I find surveillance and monitoring of would be citizens a big part of what is wrong with the “mental health” system anyway.

5. Should we really be recruiting patients and ex-patients into the “mental health treatment” expansion business? Isn’t there a degree of corruption involved here, too, as now patients and ex-patients are in the pay of the treatment (i.e. drug) industry? If there be such thing as optimal “social health”, I seriously doubt this would be the way to achieve it.

6. Please, let’s treat adults like adults instead.

7. I suggest we have more options outside of the system. Long term incarceration in an institution for seeking emergency assistance through a hotline is not my idea of a good time.

8. I’ve known emergency rooms that saw as many as 2,500 cases of alleged “mental illness” over the course of a single year. Really, I think there must be a better place for people to go to who need help with their personal problems and who are not experiencing a real and actual, that is, physical, medical condition. Doctors, nurses, orderlies, etc., don’t need the disruptive diversion.

9. Why increase “length of stay”? We’ve got a problem now with people not wanting to leave, what did you call it? Oh, yeah. “Chronic mental illness”. “Reliance on over-medication”? I’ve heard Robert Whitaker explain that the people who have done best, long term, are those who have not been introduced to psychoactive drugs. Apparently, all medication is over-medication.

10. I really don’t know how this is going to translate outside of western Finland, but I’m very wary about the matter. Open Dialogue does provide more intensive attention coupled with lower, even no, doses, and there are some potential there. However, these programs also need to be contrasted with the policing punitive Assertive Community Treatment team programs that are popping up everywhere. Those programs are not good ones.

11. Tall order, and one that you are certainly not likely to fill. Outpatient services are part of the epidemic (i.e. industrial expansion) problem I mentioned earlier. Seeing as most services are about keeping people on drugs, rather than tapering them off, you’re talking about a paradigm change across the board. Yeah, sure, when the industry is not about what it is about, allusions to “health” aside, that is, social control.

12, The paradigm change again. If you didn’t have forced treatment, no problem, however, you’re expecting the crisis intervention not to be connected to forced treatment in some manner. If the reason for treatment is to change behavior, I don’t think there is going to be a lot of scruples about methodology. Forced treatment exists. Severing crisis intervention from forced practices is, in this context, a scruple.

13, You would not be so in need of community integration if it weren’t for community segregation. I suggest you take care of the one matter, and the other should take care of itself.

14, Re-utilization, reeducation, and rehousing for screw ups and nursery school flunkies. Not such a bad idea really. It might even work.

15. Now we’re in the Insanity Defense Department, and I’m not touching it with a ten foot pole. Of course, there’s a lot of so-called “mental illness” in institutions of correction. Punishment is the pits.

16. Oh, yeah. Stop drugging people and save them, and perhaps yourselves, a lot of money. As far as the drug companies go, you can’t please everybody.

17. I think these bodies you speak of should be composed of 80 % patients and ex-patients. I don’t think they should be composed of peer advocates. A peer advocate is an advocate for system expansion (i.e. “mental illness” epidemic), isn’t he or she? I’d be more inclined to welcome people who advocated system contraction (i.e. “mental health” epidemic).

18. Corporations, including the drug industry, are really into financing continuing education. I question whether this is really about education, and whether it is not actually about system expansion. If you want to educate people, why don’t you train them in other careers besides “mental patient” and “mental health professional”.

19. No comment. This is the Mad In America website after all.

20. I don’t think this is going to go over very well. We may be due a paradigm change, but it hasn’t fully arrived yet, and until it does, people are going to claim entitlement when it comes to differing opinions.

I say first things first. End forced treatment and save yourself a lot of trouble. You’re talking about an outpatient system directly opposed to the inpatient system. Tyranny doesn’t allow for disagreement, and here it is the issues involved in forcing treatment on people that filter down into unforced treatment. Two systems in diametric opposition? This is why the outpatient system is not as you would imagine it here now. I kind of have a hard time seeing it get there as long as you’ve got a non-consensual coercive inpatient system.

As I said, I’m not angry at Robert. But his article makes me want to sigh. Reminds me of 1980’s MTV commercials. “Anti-psychiatry. Some people just DON’T GET IT.”

Would you rather I beat you with a wooden bat or a 2 by 4?
How about neither?
That’s not an option!

About number 13, I have successfully reintegrated myself into the mainstream community to some extent. How? Robert Nikkel asks.

I weaned myself off those mind altering drugs they lied to me about. They told me I would run around unable to talk and frothing like a rabid animal if I went off them. Liars.

I also moved to a place where no one knows some quack labeled me hopelessly insane. I self identify as having fibromyalgia. I suffer from all the symptoms of ME from iatrogenic damage.

I manage to go out a couple times a week. I keep clean and don’t slump over. Also lost 40 pounds so far. 🙂 I joined a church and writer’s group. No one guesses I’m supposed to be a loon.

If NAMI had their way I’d be “meds compliant” and trapped in those horrible ghettos where self-described nuts get together and talk about how crazy we are. Hey, we’re all exactly alike after all, right? Nothing but “brain diseases” embodied in flesh! My heart arrhythmia would be worse instead of better too.

As forced treatment involves forced segregation from the community, I’d say that that’s the place to start when it comes to integration, that is, getting rid of forced segregation. Voluntary segregation? What bother? You’ve got people talking about people withdrawing, if you’re going to withdraw those people to begin with, I don’t think that makes such a good argument to then start talking about integrating them. I guess what I’m saying is, you got it, baseball bat or or 2 by 4. Neither? If only that was an option.

We would know if there was reform because the mental health system and the recovery movement would no longer exist. There would be zero licensed practitioners because the government would not be allowed to issue such licenses. People would not longer be talking about healing or getting better or about recovery or rehabilitation. Instead they would be talking about the ongoing Crimes Against Humanity trials of the former mental health practitioners. We would be punishing the perpetrators, rather than further abusing the survivors.

FWIW, these two orgs look like the best anti-psychiatry orgs I can find, especially these Blue Panthers, because they are also 100% anti-psychotherapy. You cannot really be anti-psychiatry unless you are also 100% anti-psychoanalysis and anti-psychotherapy. But I don’t know that these groups have any recent activity.

You cannot really be anti-psychiatry unless you are also 100% anti-psychoanalysis and anti-psychotherapy

Not true; psychoanalysis doesn’t posit the existence of “mental illness.” “Psychotherapy” is an undefined term, it totally depends on the individual circumstance whether or not such a so-called process is helpful.

Psychoanalysis is based on trying to get the client to support socially normative views, by deploying denial. This is how Freud turned against his first 16 patients, female hysterics, daughters of his bourgeoisie friends. At first he believed their stories of sexual molestation. Freud was pilloried for this. Then just over a decade later with his Interpretation of Dreams, he said that their stories were fantasies. Hence his theory of infantile sexual desires and sexual fantasies. Always putting it back on the survivor, and usually over issues from childhood.

Today, Psychotherapy is exactly the same. They might not tell juveniles that they are lying or fantasizing anymore, because that would constitute the commission of a felony. But the whole premise of Psychotherapy is that a survivor should take no actions to obtain justice. They turn victims into Uncle Tom’s. If your therapist did not believe in this, they could not be a therapist.

So as long as someone supports psychotherapy, there response to the angry, embittered, and disgruntled, is going to be, “You need therapy”. And here on MadinAmerica, most of its psychotherapist authors say things just like this.

So nothing changes, no abusers are publicly punished, the injustices of society are not redressed. Instead the victims are told that it is they themselves who are the problem, and especially their tendencies towards aggressing and sex. And so survivors have to live in a world which does not consider their life story legitimate, because they should be seeing a therapist and learning how to deploy denial.

And so then if you support the above, at least most people will then still support psychiatry and drugs, for the more serious cases. It comes down to denying the life stories of survivors.

I would not outlaw psychotherapy, not between consenting adults, just like you can’t really outlaw fortune telling or religion. But we should discredit it and our government should be prohibited from the licensing of it.

But psychotherapy on a minor? This is always without consent. If the minor is not currently being represented by an attorney in court, then the therapist is merely an accomplice child abuser. That should be immediate handcuffs and a jail cell.

We the survivors should be making this happen, instead of debating with psychotherapists and psychiatrists, and with those in therapy and in recovery programs.

Anti-psychiatry is anti-psychiatry. That is not an endorsement of psychoanalysis, they are simply two different things. Animal abuse is horrid too, but it’s not a matter for anti-psychiatry.

You seem to miss the point about “psychotherapy,” which is probably undefinable hence hard to make any definitive statement about. “Psychotherapy on a child” which you equate with child abuse, is just as meaningless, as alarming as you make it sound. Any form of nurturance or support could be (ill-advisedly) defined as “psychotherapy,” does that make it harmful (other than for the mystification involved in the term itself)?

Psychiatry is a pseudo-medical operation which claims to be treating literal diseases. However when psychologists appropriate terms such as “bipolar” they are acting as inappropriately as do psychiatrists, and this needs to be confronted. We need to make psychiatry something other sorts of counselors get defensive about being compared to.

But the whole premise of Psychotherapy is that a survivor should take no actions to obtain justice. They turn victims into Uncle Tom’s.

Unfortunately most anti-psychiatry, not Whitaker, but most, like on this board, is just and endorsement of psychotherapy and the concept of recovery.

Psychotherapy and Recovery are based on a premise of moral defect, their version of Original Sin.

If we had this in earlier times, we would never have had an Abolitionist Movement. If people listened to it in more recent times, we would never have had a Civil Rights Movement.

Today we have legions of poor people who find that there stories are not socially legitimated. As long as they listen to Psychotherapists and Recoveryists, never will the be able to stand up and restore their honor. And often such persons are simply the scapegoats of the middle-class family.

If a child is being represented in court by an attorney, then a psychologist can provide information which will help that attorney. But if the psychologist is working for the parents, then they are helping the parents abuse that child. A court has authority over the parents. But no psychologist ever does, they are playing God in believing that they can act without inflicting harm on a child already in a horrible situation.

Talk to any therapist or recovery person about redress and legal change, they will be mortified, mortified just like religionists are. The basic lie of psychotherapy is that you can lead a good life, specifically because you do not stand up and fight to restore your honor, but instead you accept living in the limited social space which a long line of abusers has left you.

I feel safe in saying that an often result of psychotherapy, because it is based entirely on lies, is suicide. If does not expose the lies, then I would expect little better.

“It would be staffed by people who are comfortable with psychotic experiences and who actually like being around people who are suicidal, angry, confused, hearing voices, or whatever.”
I really wonder if the author has ever been around someone psychotic. If I found anyone who told me they “liked” being around someone psychotic, I would run a mile. Why would anyone “like” being around people in deep distress? It’s painful. It’s not pleasurable. It might be rewarding if you can help them, but that’s not the same.
I confess, I have never been psychotic or suicidal, but I have been “mentally ill” as a shrink would call it. I would not have felt comforted in even the nicest ER ward designed to “calm me down.” I would have felt intense distrust and fear at being surrounded by strangers. I would not have allowed myself to talk to anyone I hadn’t built up a relationship with over months if not years. There is close to zero hope that an ER of any kind can be a healing experience, in my opinion. We have to take a step back and keep people from getting to that point.
Ways to do that? Stop relying on “professionals” whether “informed” or not. We have to reach the people in the trenches so that they can look after their loved ones and spot the danger signs before crisis strikes. There will never be enough “good shrinks” to change things.
And as for ending forced treatment – it’s not going to happen. People perceived as dangerous have always been “dealt with” in one way or another. People are scared of “the mentally ill.” Sometimes they are right to be scared. It is scary seeing someone who is mad. I know it – I’ve experienced it.
Open Dialogue sounds so great – but realistically, you guys – you are talking about doing things that can change maybe about 1% of the picture. Who is addressing the big picture? Maybe people like Bonny Burstow with her book “The Other Mrs. Smith.” It’s methods like these we should be looking at, ways to reach hundreds of thousands of people, not preaching to the choir like MIA so often does.

I agree with your statement that we must quit relying on the professionals for any kind of relief. All of us need to be informed about ourselves and about medicine and must be willing to call professionals into question when we’re not comfortable with what they want to do to us. We should not immediately bow down to them in submission when they make their pronouncements about our health. Parents not willing to question the psychiatrists is what is responsible for so many children being dragged into the “mental health system.

Medicine in all its specialties and not just psychiatry, has become corrupt and making lots of money seems to be the ultimate goal. The professionals are often arrogant, believing that they are the experts on our own lives and that we must accept whatever they decide to do to us, all for our own good of course.

I’m not saying that every doctor is evil and arrogant because I just dealt with a specialist and a surgeon who were good men, people who treated me with respect and dignity. But I used to live in a neighborhood, right across the street from a university medical center, a neighborhood that was inhabited by medical students. They wouldn’t even say good morning back to you when you wished them a good morning. They would sneer and hurry on their way.

The DSM and any similar “diagnostic” manual would be gone, there would be no forced “treatment,” and psychiatrists/psychologists/therapists would not be able to testify about someone’s “mental health” in court, they could only talk about observed behavior. No drug ads on TV, and lobbying of all sorts would be taxed and the funds invested in real research. Doctors are held liable for the actual results of their actions, rather than being let off the hook if they are adhering to the “community standard of care” no matter how ineffective or destructive that “care” might be.

Of course, corporate contributions to political candidates would have to have been banned long since for such events to occur, so that’s part of the picture.

I’m reading a book called Crony Capitalism about ??? crony capitalism. This legalized bribery built into our society is bad on every level. But when it comes to “mental health” it’s ten times worse than most other areas.

Peter Breggin explains it best. People hate and fear the “mentally ill” and don’t care what happens to us–as long as they imagine we won’t gun them down in mass shootings or hack them to pieces with a butcher knife.

Anyone with half a brain could see more psych drugs aren’t the answer since more people take them then ever and the rates of random violence have skyrocketed. Even if you discount tardive akathasia, something ain’t working!

We know that more drugs is not the answer when our recovery rates were 60% or better before the arrival of thorazine and Haldol on the scene. Even then they were not referred to as “medicines” but as major tranquilizers. At least they were more honest back then. We turned something that was episodic into something that is chronic.

The whole idea of “asylum” was based upon a lie. Were people being saved from society and themselves, or was society humoring itself about being protected from its mad folk? I would suggest that what it was really all about is closer to the latter suggestion than the former.

Mad houses have been around for centuries. Remember Bedlam back in the Dark Ages? People off their rockers would wander around. If they got violent they would be locked up–by relatives if they had any.

Often these “mad” folks came back through getting three hots and a cot and lots of TLC. In The Prince and the Pauper, Miles Hendrick thinks young King Edward VI is nuts. He pities the boy, protects him, and determines to “cure” him by showing him kindness. Finally he discovers the truth about the “mad” kid and hits the jackpot. Like “Undercover Boss.”

I have read a lot of books about how madmen/women returned to sanity without drugs, regardless of what drug merchants want us to believe. Lucky for them, few read books now. I really should write an essay about the subject.

A lot of people who would be accused of “mental illness” now led productive, happy lives without psychiatric interference. Now Pharma-Psychiatry wants to eat 25% of the population. Damn greedy buzzards! Haven’t you consumed enough of humanity already?

I was going to become an English professor before Psychiatry shattered my life.

Religious institutions early on served as hospitals, St Marys of Bethlem only gets known for it’s ‘lunatics’ much later. In Elizabeth the 1st day you could count the number of mad people in St Marys on the fingers on one hand.

This number goes up 1. with the introduction of private mad houses, primarily for the well to do, in the 17th century, and 2. it really goes up with the asylum building movement that came with moral management. During the 19th centuries the numbers skyrocketed.

Before these private and public institutions, in the middle ages, the treatment of the mad was largely in the hands of their families and the communities in which they lived. With the rise of these institutions, the mad were segregated out of those communities, or at least away from their families, and confined within Mad Houses, later “Asylums”, and still later Mental Hospitals.

“A lot of people who would be accused of “mental illness” now led productive, happy lives without psychiatric interference.”

Alleged “mental illness”, we don’t know that there is any such animal to begin with. You did hit the nail on the head regarding one thing though with that 25 % of population mention. The numbers have been rising ever since they first started making a business, and a messy business at that, out of incarceration and “mental health treatment”. In my view, it is these business interests that drive the numbers, not health so much.

Frank, I said they would be accused of “mental illness.” That is not saying such a thing exists. Dr. Jamison has accused many people posthumously of being “bipolar.” Interesting how many of those people led long, productive lives without “treatment.” I asked therapists who had me read “Touched by Fire” why this was so. They hemmed and hawed and got red in the face. 🙂

Any treatment upon a minor is forced. If the minor is not currently be represented by an attorney in court, then any ‘therapy’ is just accomplice child abuse. Handcuffs, and Jail!

Our government should not be allowed to license psychotherapy, just like we don’t license fortune tellers or channelers. But if they were abusing children, they would be arrested.

The whole premise of psychotherapy is that the client still has some sort of a defect or short coming. While this may not rise to the level of ~mental illness~, it is still taking unfair advantage of the client’s naiveté. As Jeffrey Masson says, “The practice of psychotherapy is wrong because it is profiting on the miser of others.”

I think this is a useful way of organizing information as an effort to promote practical actions for change.

I personally believe that focusing on 3. (“Every person who comes in for service is provided with full informed consent about psychiatric medications”…I would add…and about all types of treatment ), and 12. (“Every crisis system will be reorganized to reduce reliance on involuntary treatment and eliminate forced medication”), is what will produce the biggest impetus for change.

Once inaccurate information stops leading people astray, and coercion can no longer force people to follow particular pathways, survivors, services users and SOs will be doing all they can to seek out the type of services that are effective, and this will put more and more pressure on service delivery modals to change.

You do realize that from the start, highlighting 3 and 12 or whatever, you’re going to have reformers from law enforcement, some quarters in the mental health movement, and the TAC working in the opposite direction, and trying to make things even more 1984ish?

What we’ve got here is lobbyist versus lobbyist with the dismissive tag, special interest group, being applied. I think it makes more sense to make force the issue rather than to pretend that you can have both force and liberty within a supposedly democratic society in a system that utilizes both. If there’s any liberty to be had here, it would be from the system that would try to impose its will on people by force.

Hey Frank,
I am not quite sure what you mean …..isn’t highlighting 3 and 12 making force the issue? (I totally agree there will be law enforcement and quarters of the mental health movement working in the opposite direction as they already are…but I would like to see critical psychiatrists, psychologists, mental health workers, S0s, law makers and enforcers channel their energies mostly towards these issues because it would then allow more movement as a whole)…What am I missing?

Imagine a gauge to measure reform. There is the middle of the gauge, and on one side you’ve got more restriction, and on the other side you’ve got less. The reforms you are looking at are merely a matter of turning the arrow lower down on the less restriction side. Both sides are reformist. Abolish forced psychiatry, and there is no longer any reason for reform because you are no longer “restricting” people. The whole game is based upon mental health law, a law that should be repealed, and represents for one thing the law enforcement end, but it also represents the “mental health” professional and worker end, too. Business would be down, job security lessened, and their livelihoods on the line if psychiatry were not, to some degree, involuntary. Those who mental health law doesn’t represent are those who don’t want to be forcibly treated.

Here’s a 13 for Robert Nikkel’s consideration. Every time a parent drags in an adult child to be diagnosed for an SMI, the whole family must be subjected to psychiatric screening. The Golden Child, all the Flying Monkeys, and the “Narcissist” him/herself. (I am not using “Narcissist” as a term for “mental illness” but the central role in dysfunctional family dynamics. “Flying Monkeys,” “Golden Child,” and “Family Scapegoat” can’t be found in the DSM 5 but are equally apt labels for the roles in the drama. Drama Queen Bee would be a better term for the person at the center of the mess.)

That would put a monkey wrench in the NAMI mommy movement. Shrinks will be glad to gain more consumers and sell more drugs/ECT; so they would agree to this idea. “Mental illness” is supposed to be hereditary after all. 🙂

Oooh, I LIKE it! The parents and siblings have to undergo screening for abusive and crazy-making behavior, and THEY get locked up if they fail the screening!

Not really, of course, because they’d just lock everybody up and put the whole family on drugs, but I like the concept of the “kind, caring parents” who often contributed to the situation in significant ways putting their scapegoat in the psych ward and getting off without consequences.

To be clear, I understand that the majority of parents do care about their kids and are trying to do the right thing, and many people end up in the ER despite caring and sane parents. But there’s a huge overlap between abusive parents and emotionally upset children, and psychiatry has been working hard to eliminate any knowledge of that fact.

In the 1970’s I worked in the largest psychiatric facility on the Gulf Coast. It took people from Florida, Alabama, Georgia, Mississippi, and Louisiana. It was private and owned and run by an order of Roman Catholic nuns.

The first year I was in training there I met an entire family that was being held there, minus the father. He happened to be a colonel in the Air Force and he forced his wife and five daughters into the “hospital”. After dealing with the oldest daughter over an extended period of time I was of the firm opinion that the father was the one who should have been locked up with us and the wife and daughters freed. Talk about an abusive man.

My own parents were not abusive. My childhood was screwed up without their consent or (sometimes) knowledge.

1. I irritated a Sunday school teacher because I daydreamed and asked too many questions. She told me I was wicked and frequently regaled all her pupils with tales of Hell. My brother and I had nightmares. Years later our parents found out. We didn’t tell on Mrs. X because she was a grown up and could do no wrong. We were taught to always obey grown ups unless they were strangers offering us rides or candy.

2. Dad got kept getting fired from churches and we would be homeless for several months at a time. The Church of Christ treats its clergy horribly and has no bishop to help preachers and families relocate. I started to have nervous attacks as a teen after trying out with Dad at multiple churches. Fainting spells and agoraphobia. Quit talking to anyone but immediate family members and a very few friends for much of high school.

3. Was sexually harassed for two years in high school. Almost every day of the school year. It sounds silly, but I was a very modest girl and the horrible stuff the lizards at school described made me physically sick. I couldn’t keep my food down. I tried to wear baggy clothes that covered everything below my neck and keep my hips from moving when I walked! Nothing helped! I went on very low calorie diets. My curves were responsible for inciting lust despite my best efforts to do right and I hated my body for a long time.

In college things were better externally. But I continued to hyperventilate and have flashbacks. Even small social groups terrified me. Finally I couldn’t leave my dorm room.

Getting rid of forced treatment would be excellent.
But – does anyone know what the relative percentages are of people forced onto treatment (drugs or incarceration) versus those who go seeking drugs?
My guess is that the latter group massively outweighs the former.
And in an environment where a large majority supports the idea that drugs help, a correspondingly large majority will support the idea that some people need to be “helped” forcibly, “for their own good.”
How can we counter the megabucks invested in pushing the “drugs are the solution” narrative?

Also, I suggest that the once-upon-a-time there was less “mental illness” is more to do with the breakdown of communities; the breakdown of conventional morality; the pursuit of happiness as a goal in life – than anything else, including big business. They just hooked up with something that was already happening – they didn’t create this mess. We did.

Actually, I’ve observed a huge gray area between people seeking these drugs and people being forced to take them. Kids, for instance, often have no choice at all about it. Same with elderly or disabled folks in many cases. And many adults “voluntarily” take these drugs because they understand that refusing will mean trouble for them. Beyond that, there are many more who “voluntarily” take these drugs because they are lied to about their “condition” and about the drugs’ effectiveness and dangers, and have been denied any access to or knowledge of any alternative options, and they are also often pressured by counselors, doctors, and/or family members to take the drugs against their own intuitive discomfort. So it’s not really very easy to distinguish between those seeking drugs, those taking them because they think they should, those taking them because they’re afraid of what would happen if they refused, and those who are overtly forced to take them. It’s an ugly scenario by all accounts.

I take your point. So, the question remains: What can we do to combat the megabucks invested in their version of the story? They are offering hope in the form of a pill. What can we offer? Even if we could persuade everyone that the pills are killing them, what do we have to offer instead?
There will be no successful revolution without painting a picture of the better tomorrow it can bring. Yes, many people will do much better without drugs even if they don’t have the support system they really do need. But it’s not going to be enough to tell them that. Pills offer the illusion that “everything’s going to be fine now.” So what do we have to offer instead?

It’s not our responsibility to provide an alternative illusion. The only lasting answer IS revolution. People are not reacting to imaginary problems, but concrete realities inherent to this social/governmental system. So there’s no way for them to truly “feel better” when all those contradictions are still present; contradictions that can only be ameliorated when private profit is no longer the driving force in the world. All we can do is support each other along the way.

I feel the system should just leave people who want to be left alone alone. I don’t think you need a social/economic revolution to leave people alone. The only kind of revolution in “mental health” we need is the repeal of mental health law, that is, the abolition of forced treatment. Sure, there are social and financial reasons for people’s difficulties, but those difficulties are other than forced “mental health” treatment. If your revolution doesn’t abolish forced treatment, we’d still need to abolish forced treatment. Revolution has too many connotations that have to do with violence. I’m not sure any violence would be required, only I’m sure of one thing, you don’t need a revolution to get rid of forced “mental health” torture. You need to change the law because the problem is the law. It’s bad law, and we need to change it, but forced treatment is the law.

If the Mental Health System were reformed, then there would not be licensed therapists on a forum like this promoting psychotherapy, healing, and recovery. All of that is must more abuse of survivors. And that the government licenses psychotherapists makes them radically more dangerious than faith healers, psychics, channelers, and fortune tellers. We must stop our government from being able to issue such licenses.

Remember, if you are lying on the couch confession, that guy in the arm chair listening to you is a government mind control agent.

Robert, Please share how Oregon’s mental health system moved towards reform when you were its Director of Mental Health and Addiction Services. How was this change measured? What impact did it have on outcomes? Thank you.

I left my position (actually, I was fired for raising questions about “integrated healthcare”) in 2008 before I had read anything by Bob Whitaker. So I would do things differently now–and almost certainly get fired much sooner. As it was, I did last almost 6 years, a long time for state mental health commissioners who usually last about 18 months–not much time to get much done. That’s one of the perspectives that I have–it’s very difficult to do reform in state systems. Frankly, abolishing the mental health system just isn’t going to happen if you understand even the first things about legislators. I realize by sharing what we collectively accomplished during my 6 years in leadership, I am just opening myself up to more criticism but this will at least answer your question. As I stated, I would do many things differently now. Please note that I was also the director of addiction services.

Here goes:

Increased services for people with addiction disorders – AMH is overseeing statewide implementation of $16 million in new funding for services for people with alcohol and drug abuse problems. Under the Intensive Treatment and Recovery Services Initiative, $10.4 million is directed at families whose children are in or at risk of being in the child welfare system due to parental substance abuse. Twenty-eight counties and tribes are participating in the evidence-based Strengthening Families Program, aimed at decreasing adolescent substance abuse and aggression through the promotion of better parenting and child-parent relationships.
Children’s Mental Health System Change Initiative – More children are enrolled in managed care and receiving community mental health services as a result of AMH’s Children’s Mental Health System Change Initiative, which began in late 2005. The changes have increased supportive and wraparound services for kids and reduced lengths of stay in institutional care facilities. Families are more satisfied with coordination, participation, treatment, and outcomes. Treatment is linked to increased school attendance, a decline in school suspensions and expulsions, and decreased arrests.

Problem Gambling Awareness Program – This AMH unit created an award-winning problem gambling awareness video featuring Oregon youth and distributed it and a facilitator guide to all Oregon middle schools. The unit sponsored a youth problem gambling prevalence study, one of the first in the nation to include parents and to report that young people are gambling online. The study indicated that parents need to learn more and advise their children against the online games, which start for free and then begin collecting money. The study indicated that 1.3 percent of Oregon adolescents are problem gamblers, and another 4.6 percent score as at-risk gamblers. Also a college problem gambling prevention and awareness initiative is taking hold on four major campuses – Portland State University, Oregon State University, University of Oregon and Oregon Health & Science University. And the program added an online (chat, instant message, email) component to the Oregon Problem Gambling Helpline to reach more youth.

Housing – In 2005-07, AMH invested $6.15 million in residential development projects to transition people from institutional settings and homelessness, and to create housing for people with barriers to residential stability. The housing, valued at $55 million, includes 24 residential facilities/homes, four transitional housing programs and 14 supportive apartment complexes. Twenty-nine projects were initiated in 18 counties to house 363 people with serious mental illness, including housing for 287 people leaving psychiatric hospital facilities. There were seven projects in six counties to house 54 residents in recovery from alcoholism and drug addiction. Using these new residential programs and other community settings, 128 individuals were moved from state psychiatric hospitals to community settings.

Evidence-based practices – Addictions and mental health treatment systems exceeded statutory requirements (ORS 182.525) for delivering evidence-based practices with at least 25 percent of the 2005-07 budget. AMH surveys indicate that 33 percent of mental health expenditures and 54 percent of addictions expenditures were for evidence based practices. There are more than 150 approved practices from which providers may choose. AMH is reviewing the fidelity of providers in delivering the approved practices. AMH staff and stakeholders developed procedures for evaluating and approving practices, contract language, fidelity monitoring, and readiness assessment. The system is scheduled to deliver evidence-based practices with at least 50 percent of the service expenditures in 2007-09.

Dual Diagnosis Anonymous – Over 100 of these critical self-help groups have been established in the last two years, serving people with both mental health and addiction disorders. These peer-directed groups support people in recovery and foster their success in the community. Over 1,200 members are now actively participating in recovery from co-occurring disorders.

Wellness Initiative –An AMH wellness committee is working with people who are recovering from mental illness to improve their health and longevity after a recent study indicated they often die much younger than others in the general population. They are working to improve health and wellness by sharing information on scientific research, literature, peer guidance, and successful practices among user groups. The committee is made up of those in recovery, DHS staff members, physicians, health and wellness professionals, and others.

Jail Diversion programs – AMH is distributing $4 million authorized by the 2007 Legislature for jail diversion programs in all 36 counties. These programs are aimed at individuals charged with low-level crimes whose treatment needs are best met in a mental health setting rather than a county jail with fewer treatment resources. The programs involve intensive case management, which includes working with courts, parole and probation officials and others to ensure that treatment, housing and other client needs are being met.

AMH supports drug treatment court services – Oregon’s 47 drug courts are helping to reduce drug use and re-arrests among people involved with drugs and the criminal justice system. And they save counties money on corrections costs. Drug court participants must go through a long-term, structured, supervised and coordinated multi-agency treatment program before they are eligible for “graduation.” AMH supports services that are essential to drug courts, such as outpatient and residential treatment for drug and alcohol addiction, detoxification, mental health treatment, and housing and peer services aimed at recovery.

AMH funds early psychosis programs – In December 2007 AMH selected two organizations and three counties to receive $3.02 million to conduct early psychosis programs, which aim at helping young people who experience psychosis to stay on their normal developmental path with as little disability as possible. Oregon is the first state in the nation to expand availability of these life-saving invention programs beyond very limited pilot projects to half of the young people in Oregon experiencing their first major psychotic episode. The funding for programs serving approximately 200 young people is: Deschutes County, $535,993; Multnomah County, $1.15 million; Washington County, $843,599; Greater Oregon Behavioral Health, Inc. (for Clatsop, Columbia and Union counties), $410,561; and Mid-Columbia Center for Living, $180,169.

Network for the Improvement of Addiction Treatment – Fifty Oregon treatment providers are participating in the Network for the Improvement of Addiction Treatment, or NAITX 2000 project. It is designed to help people with drug and alcohol addictions get into treatment, reduce the waiting time to start treatment, and increase the likelihood they will remain in treatment long enough to benefit. AMH is managing the federally financed research project, which is evaluated by the Oregon Health & Science University. The goal of the project is to gauge what technical assistance is most effective in helping treatment providers improve outcomes.

Promoting Medicaid Funded Peer Delivered Services: The Addictions and Mental Health Services Division (AMH) recognizes the indisputable value of peer delivered services in transforming a mental health service delivery system that is based on the recovery model. AMH will work with consumers/survivors and stakeholders to develop strategies to increase the use and availability of peer delivered services. The largest funding source for community-based mental health services in Oregon is Medicaid.
AMH Cultural Competency Plan: The purpose is to establish cultural competence standards, values, and policy requirements for AMH and all organizations and agencies that receive grant funds from, or that are under contract with AMH, including county social services organizations and their vendors or contractors, managed care organizations and their provider networks, and community-based organizations. It is the intent that this will serve as a planning document to assist AMH, County Governments, and provider networks to develop and implement an individualized cultural competence plan as addressed in each County’s bi-annual implementation plan, with its goal to enhance treatment outcomes for all patients.
Mental Health Emergency Preparedness Response Plan: The Division has completed a comprehensive emergency preparedness plan in collaboration with other key stakeholders in state and local government.
Negotiation of Co-Management Plan: The Division negotiated into county intergovernmental agreements for the first time a section which makes counties ultimately responsible financially for any patient deemed ready to discharge who is not placed in the community in a timely manner. This is a major step forward in working out details of how Oregon can be consistent with the Supreme Court’s Olmstead decision.
OSH Census: The Division and community partners, both county and non-profit, have worked diligently to increase the number of placements available for persons ready to leave the state hospitals and have decreased significantly the number of persons who are civilly committed and also decreased the number of beds needed in the state hospital for longer-term civil commitment stays.
Miranda B Settlement: The Division was able to reach a settlement on the Oregon Advocacy Center’s Miranda B lawsuit by agreeing to create a significant number of new placements in the community. Community resistance has made complete fulfillment of all goals difficult but Division staff and county/community programs have worked diligently and in good faith to create hundreds of new places for persons leaving the state hospitals to continue their recovery in the community.
EOPC Name Change: The Division worked with 2005 Legislature to change name of EOPC to BMRC (Blue Mountain Recovery Center) following receipt of a petition signed by an overwhelming majority of patients at the state facility in Pendleton. This reflects a considerable transformation of thinking about how people in state hospitals are viewed and treated in their movement toward a real life in the community and recovery.
Reduced use of Seclusion and Restraint in state hospitals and local acute care units. Data has clearly indicated a consistent and long term decline in the use of seclusion and restraint in the most highly restrictive levels of care for adults.
Created PAITS (Post Acute Intermediate Treatment Service): PAITS is a mix of rehabilitation services designed for adults who have received acute psychiatric care services in a local hospital and who have been approved for Long-Term Psychiatric Care.

Children’s Mental Health:
• Closed state hospital units for children and adolescents and opened successful community programs as alternatives.
o Secure Children’s Inpatient Program & Secure Adolescent Inpatient Facility
• Children’s System Change Initiative – outcomes data has shown a significant decline in out-of-home and other residential treatment for the most challenged children and adolescents in Oregon.
• Children’s Medical Director – this position was established for the first time rather than the adult-focused Medical Director positions in the past. The AMH Medical Director has proposed a Position Description which will allow for a shared position with Children, Adults, Family Division as a model for future development and current integrated work between the two Divisions.
• Developed plan to increase percentage of MH assessments for children placed in out-of-home care under CAF in order to provide better services and to meet a federal requirement that has long been neglected.

Adult Mental Health
• Governor’s Mental Health Task Force Report prepared and issued in 2003
• Implemented the 20-hour Personal Care option as a way to avoid major cuts in 2003 and begin supporting peers delivering support services.
• Jail Diversion Projects implemented in all counties following the 2007 Legislature’s approval.
• Established a consumer/survivor council; codified in statute by 2007 Legislature
• SB 267 implementation is on track to achieve the 75% required funding levels for 2009-11.
• Expanded Secure Residential Treatment Facilities to 21
• Resolved 15 Acute Care issues in summer of 2008
• Enforced Umatilla County intergovernmental agreement by revoking the certificate of approval in 2005 and re-contracting to Lifeways.
• Community Services workgroup provided a framework for “front end” and “back end” services in order to make the OSH replacement facilities work.
• Olmstead Plan has been completed in 2008; will be modified as needed in next year.
• Supported Employment pilot projects have served as national and state models for this evidence-based and recovery service.
• Agreed on MHS 20 allocation formula (Kessler) with counties to achieve an equitable distribution of non Medicaid State General Funds for adult and crisis services.
• Returning Veterans Workgroup is scheduled to initiate review of needs.
• Wellness Initiative established to reduce the years of lost life expectancy for adults with major mental illness, perhaps the single greatest health disparity at this time in all of Oregon and around the country.
• Dual Diagnosis Anonymous – 300 gps/week and growing
• NAMI – Report Care Top 10 with 40th per capita funding

Transition Age Youth
• Established EAST and first state to extend to ½ state
• New position for Transition Age Youth
• 1st statewide Transition Age Youth conference in country in summer 2008

Children’s A&D
• Re-established Prevention Manager position and hired national expert
• Adopted Risk & Protective Factors as framework for focused prevention services
• Established list of EBPs
• Children’s Intensive Treatment Program with CAF implemented statewide in 2007-08/
• Developed Policy Option Package of $12 million investment in prevention
• Suicide prevention services have been developed in close collaboration with Public Health Division and Oregon Partnership

Adult Addictions
• Established EBPs and met 2007-09 goal of 50% in 2005-07
• Developed Community Addiction Plan with Governor’s Council
• Elevated visibility of addictions by restructuring and renaming AMH and creating Addiction Manager position
• Led implementation of NIATx and SBIRT treatment improvement initiatives
• Established co-occurring specialist position and issued first Dual Diagnosis Directory with 122 programs statewide

General
• Initiated Hispanic Mental Health Workgroup to begin in Fall 2008
• Brought MH budget in balance without need for other Division assistance
• OAR simplification plan established
• Performance outcomes data sheets & expansion to six program areas and six outcome measures
• Morbidity/Mortality study completed in 2007 by Program Evaluation Unit consistent findings with about 9 other statewide studies
• Research collaboration with PSU, OHSU (SB 267, etc.)
• AMH forwarded 80 Policy Options Packages (POPs) for a needs-based budget to be considered by the Governor
• Switched General Funds to Medicaid in order to avoid dismantling MH system in 2003

State Hospitals

• Reduced LOS by 30%
• Master Plan completed and is on schedule and within budget
• Worked with Oregonian editorial Board in Pulitzer Prize winning series on OSH
• Transformed state hospital union adversarial relationship to collaboration
• OHSU collaboration – created contract for improving MD services at Oregon State Hospital
• Planning for new approach to state hospital recovery model to treatment mall
• Established state hospital CFO position
• Peer Bridgers project approved
• First state hospital in the nation to implement Supported Education (over 100 patients enrolled)
• Regained Joint Commission and CMS certification
• Created Continuous Improvement Plan, retained 2 national experts to consult and lead culture change
• Gained legislative approval for 211 new staff
• Completed Psychiatric Nurse Workforce Development Plan
• Resolved Harmon v. Fickle lawsuit
• Developed DDA groups in State Hospital
• State established “Ready for Discharge” criteria